Healthcare Provider Details

I. General information

NPI: 1750456562
Provider Name (Legal Business Name): GERALDINE EUSEBIO MARIANO N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 30TH ST FL 2
SAN FRANCISCO CA
94131-2420
US

IV. Provider business mailing address

33 TREESIDE CT
SOUTH SAN FRANCISCO CA
94080-2437
US

V. Phone/Fax

Practice location:
  • Phone: 415-550-2242
  • Fax: 415-550-2229
Mailing address:
  • Phone: 650-583-8341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number15985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: